A non-government entity
Simply More (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply More (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply More (HMO) in 2025, please refer to our full plan details page.
Simply More (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Miami-Dade. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Simply More (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Simply More (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Simply More (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3450.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Simply More (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Simply More (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay the following costs for drugs in each tier until your total drug costs reach $2000. For preferred generic and standard generic drugs, there is no copay. For preferred brand drugs, the copay is $30 at a preferred pharmacy and $35 at a standard pharmacy. If you are in the non-preferred drug tier, you will pay 33% coinsurance. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Simply More (HMO) plan offers a wide array of benefits with varying costs. Many services like primary care visits, hearing exams, vision services, and dental services have no copay. Additionally, the plan covers inpatient hospital stays, outpatient services, and emergency services, with some services having copays and others having coinsurance. This plan also provides coverage for ambulance services, home health services, and skilled nursing facilities. Prescription hearing aids are covered with a plan-specified amount of $2,000 per year, and the plan offers additional benefits such as over-the-counter items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization and a doctor referral. For Inpatient Hospital-Acute, there is no copay for a Medicare-covered stay, and additional days are covered for 3 days with no copay per day. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay of $0-$50, observation services, ambulatory surgical center services, and outpatient blood services have no copay, and outpatient substance abuse services have a $50 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Simply More (HMO) plan, with no copay required. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
The Simply More (HMO) plan covers ambulance and transportation services, including services not usually covered by Medicare. Ground ambulance services have a $75 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Simply More (HMO) plan. Emergency Services have a $50 copay with no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $50 copay with no coinsurance.
Primary Care See details
The Simply More (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, mental health specialty services, podiatry services, additional telehealth benefits, physical therapy and speech-language pathology services all have no copay. Occupational therapy services, other health care professional services, psychiatric services, and opioid treatment program services all have a copay, with opioid treatment program services having a $50 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, additional preventive services, and kidney disease education services. Medicare-covered zero dollar preventive services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay. Annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and telemonitoring services are not covered. Health education, personal emergency response systems, fitness benefits, remote access technologies, and home and bathroom safety devices and modifications have no copay.
Hearing Services See details
Hearing exams are covered with no copay, as are routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a plan-specified amount of $2,000 per year, and no copay.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a maximum benefit of $350 per year.
Dental Services See details
Dental Services are covered by the Simply More (HMO) plan, with no copay for Medicare Dental Services, Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery. Fluoride Treatment, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Simply More (HMO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by Simply More (HMO), including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance. Prosthetics/Medical Supplies - Non-Medicare benefit, Prosthetic Devices, and Medical Supplies are also covered, with 20% coinsurance for Medical Supplies and 20% coinsurance for Prosthetic Devices. Diabetic Equipment is covered with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services have no copay. Diagnostic and Therapeutic Radiological Services have a copay up to $25, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Simply More (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Simply More (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, but for days 21-100, there is a $20 copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Simply More (HMO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum plan benefit coverage amount of $80.00 per month. This plan also covers a meal benefit with no copay, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved